Cardiac rehabilitation for a skydiver after aortic valve replacement for pure aortic regurgitation and resection of the ascending aorta complicated by active infective endocarditis and heart block requiring a pacemaker.

A professional skydiver underwent aortic valve and ascending aorta replacement complicated by infective endocarditis with root abscess and pacemaker implantation. He then enrolled in the Baylor Heart and Vascular Hospital cardiac rehabilitation (CR) program as part of its specificity of testing and exercise training facility. He performed specific skydiving cardiovascular and muscular strength tests at the beginning and the end of the CR program. His pacemaker was interrogated to ascertain any arrhythmias or lead displacement over the course of the CR program. Daily exercise training was customized to match the physical demands of skydiving, including two sessions at iFLY Dallas. Upon completion of the daily exercise sessions, the patient performed a simulated free-fall drop test. He then performed a true jump at Dallas Skydive Center and subsequently traveled to Arizona for a skydiving competition, where he performed 35 true jumps with no adverse events or symptoms. This case illustrates how CR, tailored to a patient's specific needs, can aid in the return to rigorous activity.

Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities. After the 1 repetition maximum (1-RM) was assessed, the subject performed the bench press at the following intensities, first with controlled breathing and then with the Valsalva maneuver: 40% of 1-RM (low), 70% of 1-RM (moderate), and 1-RM (high). Next, various nasal irritants were used to induce a sneeze. The forces on the sternum were calculated according to a cylindrical model, and a 2-tailed paired t test was used to compare the mean force exerted during a sneeze with the mean force exerted during each of the 6 bench press exercises. No statistically significant difference was found between the mean force from a sneeze (41.0 kg) and the mean total force exerted during moderate-intensity bench press exercise with breathing (41.4 kg). In conclusion, current guidelines and recommendations limit patient activity after a median sternotomy. Because these patients can repeatedly withstand a sneeze, our study indicates that they can withstand the forces from more strenuous activities than are currently allowed.